As Massachusetts pours millions of dollars into its war on opioid addiction, substance abuse counselors are warning that patients - even teenage addicts - are being over-medicated with methadone, buprenorphine and other treatment drugs. A major article in The Salem News offers some valuable lessons for anyone battling the opioid epidemic.

Fueled by prescription painkillers like OxyContin, Percocet and Vicodin, and cheap heroin pouring into the country from Mexico, opioid addiction and overdoses have been escalating throughout Massachusetts for several years. To combat the problem, the state has budgeted $114 million this year to provide more treatment and prevention programs. But state officials are placing major emphasis on replacement drugs such as methadone, buprenorphine and Suboxone - called medication assisted treatment, or MAT. These drugs, addictive and dangerous opioids themselves, are used to block the opioid receptors in the brain to prevent withdrawal symptoms that may trigger a relapse after the addict stops using heroin or opioid painkillers. The theory is that they will slowly taper off the medications until they are drug free. But professional counselors in the state say there's too much reliance on methadone, buprenorphine and other opioid-based MAT drugs. Counselors interviewed for a major article in TheSalem News recently said they'd rather see more money being spent for more long-term treatment programs to help addicts get their lives back without the risk of addiction to MAT drugs like methadone.

Medication assisted treatment is not the only answer

Joanne Peterson is the executive director of Learn to Cope, an advocacy group that counsels families of addicts. Speaking to The Salem News recently, Peterson said, "There's this growing perception that medically assisted treatment is the only answer, but it's not," she said. "I've seen methadone save people's lives, but it really concerns me that 18- and 19-year-olds are being put on it." Peterson told the Salem News about a discussion with public health officials about the growing number of addicts in state-funded treatment centers receiving methadone and other drugs. "There was one healthcare worker who was talking about how their methadone clinic has tripled in patients in the past year," Peterson said, "and she was smiling when she said it, as if that were good news. That made me feel sick, really sick." The facts are that effective long-term, drug-free rehabilitation is helping people get their lives back every day, all over the country.

Even the governor is having second thoughts

Expanding access to medication-based treatment was a key recommendation of the task force that Gov. Charlie Baker set up last year to combat the opioid addiction crisis. According to state officials, opioid addictions claimed more than 1,200 lives in 2014. The $114 million that Baker's administration provided has helped buy countless doses of medications. And it has also funded more beds for state-run detox and treatment centers as well as prevention and law enforcement efforts. According to the Salem News, Baker spent much of his first year in office "wrestling with the opioid crisis." But he now agrees that treatment centers need to do a lot more than just hand out medication. "One of the problems with the system is that some people think they're either methadone or Suboxone providers and don't see themselves as being in the addiction treatment business," Baker told TheSalem News. "We want to make clear to the treatment community that all options should be part of the conversation." However, according to the News, no figures are available showing how many addicts are being treated in state-run treatment centers or how much the state is spending on the medications for treatment.

Is MAT helping people get their lives back in a reasonable time?

Methadone has been used for decades to "treat" heroin addiction. More recently, Suboxone (a mix of buprenorphine and naloxone) has become a preferred treatment in some areas. However, methadone might cost upwards of $3,500 a year per patient, according to Salem News, while even the generic form of Suboxone can run two or even three times that according to the National Association of State Alcohol and Drug Abuse Directors (NASADAD). Both methadone and buprenorphine are heavily addictive, are often diverted to street sales, and even smuggled into prisons on a regular basis. Both drugs can also cause fatal overdoses, especially when combined with other central nervous system depressants such as alcohol, barbiturates and antidepressants. And the need to stay on these drugs, especially methadone, can go on quite literally forever for some people, the patient permanently tethered to the nearest methadone clinic by the proverbial "methadone handcuffs." The Salem News also spoke to former state Sen. Steven Tolman, who was a member of Baker's opioid task force. Tolman has been involved in substance abuse issues for years, and said he agrees that health officials today are "much too quick" to prescribe opioid-based medication for treatment. "Alternatives such as abstinence and holistic treatment are too seldom part of recovery programs," he said. "We're fighting a major epidemic, so the last thing we should be doing is giving out more addictive medication." Because the state lacks long-term treatment options, especially for homeless and low-income addicts with no insurance, healthcare providers simply turn to MAT. "There's a lot of situations where physicians' hands are tied because there's no long-term care," he added.

Treatment is complicated and profitable

It's clearly understood by all concerned that addiction treatment varies from person to person. "There's really not a one-size-fits-all answer," Linda Corso told the Salem News. Corso is a program director at the John Ashford Link House, a non-profit treatment center with several locations in the state. "We have people who have tried medication treatment and come here because they want abstinence, and others who have tried it on their own and couldn't do it without some kind of assistance." Many people who are taking medication for addiction can't get into long-term residential treatment programs. "A lot of sober houses won't take people on medication because there's a potential for abuse. And they don't want to have to deal with checking medication levels or people selling their doses. There's a lot of issues," she added. Scarcely a day goes by that we don't get a call here at Novus from a patient who is desperate for help with getting off methadone. Fortunately, Novus has the expertise to do just that.

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